IN THE CASE OF: BOARD DATE: 27 January 2023 DOCKET NUMBER: AR20220006071 APPLICANT REQUESTS: in effect, his service record reflect his medical conditions are combat incurred and in the line of duty (LOD). APPLICANT'S SUPPORTING DOCUMENT(S) CONSIDERED BY THE BOARD: * Two DD Forms 149 (Application for Correction of Military Record) * VA Form 21-0781 (Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD)) dated 5 July 2019 * DA Form 2823 (Sworn Statement) dated 13 July 2019 * Department of Veterans Affairs (VA) Letter dated 15 March 2022 * VA Disability Rating Snapshots * Joint Base Balad Burn Pit Fact Sheet (2 pages) * VA Training Letter on Environmental Hazards (27 pages) dated 26 April 2010 FACTS: 1. The applicant states his medical discharge was deemed not related to military service; however, the VA has deemed his medical conditions service connected and awarded him an 80% disability rating. His “Non Line of Duty” discharge needs to be upgraded to reflect it occurred in the line of duty with an effective date of 5 August 2021. The decision made was attributed to attempting to rush medical practices to meet a deadline of 23 August 2021. The findings and ratings were made on 5 September 2021, following his orders for discharge. Medical practices should not and cannot be rushed. 2. The applicant provides: a. A VA Form 21-0781 dated 5 July 2019, wherein the applicant states he served in numerous locations where the local Iraqis were killed. He also witnessed a “justice killing,” where the person was shot in the head, doused in fuel, and left on the side of the road. He was tasked with confirming the death. The memories of Iraq burn vividly in his head nearly every day. There were numerous occasions in which he was affected not only by what he saw, but also by what he did. They detained several locals setting up improvised explosive devices (IEDs) near their camp and the only reason they did not kill them was because they had a 5-year-old with them and were training him on setting up IEDs. For some reason his claim was removed from the system and he as not able to locate it, so he was providing it again. The applicant also served on the detainee operations team conducting 12 hour day rotations with multiple mortar attacks. The base was on high alert after the head of Al Qaida in Iraq was taken out. b. A DA Form 2823 from the applicant dated 13 July 2019, indicated he deployed three times and was collocated with designated burn pit locations. He initially began noticing symptoms in 2013 due to a gradual decline of his Army Physical Fitness Test (APFT) scores. He began to seek assistance from the VA in 2015 when the symptoms became excessive. In all of his deployments, he woke up and fell asleep to a smokey haze. c. A VA letter dated 15 March 2022, listed the applicant’s period of honorable service and further noted he was service connected for one of more disabilities and received an 50% disability rating. He was not considered to be totally and permanently disabled. d. A VA disability rating snapshot shows the applicant received an 80% combined disability rating for the following service-connected disabilities: * asthma – 30% * PTSD – 70% e. A Joint Base Balad Burn Pit Fact Sheet (2 pages) is provided to assist Service members with better understanding exposures to, and potential health risks from, airborne pollutants at Joint Base Salad (JBB), Iraq. It also serves as a reference for other deployment locations where Service members may have had similar exposure concerns. The full article is available for review by the Board. f. A VA Training Letter on Environmental Hazards (27 pages) dated 26 April 2010, available for review by the Board, outlined three main purposes: * to inform regional office employees on specific environmental hazard incidents that present potential health risks to service members and Veterans * provides guidance on handling claims for disabilities potentially resulting from exposure to environmental hazards while on active duty * provides "fact sheets" that may serve as valuable resources for VA examiners when they conduct Compensation and Pension (C&P) examinations associated with such exposure 3. A review of the applicant’s service record shows: a. He enlisted in the Washington Army National Guard (WAARNG) on 27 January 2010. b. The applicant’s service record is void of the medical examination documents conducted at enlistment. c. Orders 019-33 dated 31 January 2001, ordered the applicant to initial active-duty training (IADT) with a report date of 21 June 2001 for approximately 10 weeks. d. He was honorably released from active-duty training on 13 September 2002. His DD Form 214 (Certificate of Release or Discharge from Active Duty) shows he completed 1 month and 22 days of active service. It also shows in Block 11 (Primary Specialty) 12B, Combat Engineer. e. Orders 024-075, dated 27 January 2003, ordered the applicant to active duty with a report date of 25 January 2003 for a period not to exceed 365 days. f. He was honorably released from active duty on 7 June 2004. His DD Form 214 shows he completed 1 year, 4 months, and 13 days of active service. It also shows in Block 18 (Remarks) the applicant served in Fort Lewis, WA, Kuwait, and Iraq, but it did not specify time periods in each. g. Orders 172-326, dated 21 June 2005, ordered the applicant to active duty with a report date of 18 August 2005 for a period not to exceed 230 days. h. Orders 023-0015, dated 23 January 2007, released the applicant from active duty, not by reason of physical disability, with an effective date of 12 February 2007. i. He was honorably released from active duty on 12 February 2007. His DD Form 214 shows he completed 1 year, 5 months, and 25 days of active service. It also shows in Block 18 (Remarks) the applicant served in Iraq from 27 November 2005 to 11 November 2006. j. Orders A-02-704702, dated 27 February 2007, ordered the applicant to active duty with an effective date of 6 March 2007 for a period of approximately 365 days. An amendment was published Orders A-02-704702A01, dated 4 April 2007, changing the period of active duty to 11 months and 28 days. k. He was honorably released from active duty on 19 May 2008. His DD Form 214 shows he completed 1 year, 2 months, and 14 days of active service. A deployment period was not reflected on the DD Form 214. l. Orders 144-279, dated 23 May 2008, ordered the applicant to active duty with a report date of 18 August 2008 for a period not to exceed 398 days. m. Orders 217-1112, dated 5 August 2009, released the applicant from active duty, not by reason of physical disability, with an effective date of 22 October 2009. n. He was honorably released from active duty on 22 October 2009. His DD Form 214 shows he completed 1 year, 2 months, and 5 days of active service. It also shows in Block 18 (Remarks) the applicant served in Iraq from 25 October 2008 to 2 August 2009. o. On 26 January 2020, the applicant was honorably discharged from the WAARNG. His NGB Form 22 (National Guard Report of Separation and Record of Service) shows he completed 19 years of net service for the period. Block 23 (Authority and Reason) indicated the applicant’s discharge was due to expiration of term of service. p. On 25 May 2021, the applicant was notified the State Medical Evaluation Board (MEB) conducted a “fitness for duty” evaluation on his medical conditions having reviewed his medical records. The board determine the applicant was medically disqualified for continued military service. The applicant had the option to concur or to rebut the decision and request further evaluation by a Non-duty Related Physical Evaluation Board (PEB) by no later than 23 August 2021. q. A Rebuttal/Election Processing memorandum, dated 1 June 2021, was not completed and did not include elections. r. A NGB Form 23B (Army National Guard Retirement Points History Statement) dated 1 June 2021 was included and summarized the applicant’s points earned towards retirement, a total of 3222. s. Orders 0001442276.00 dated 5 October 2021, honorably transferred the applicant to the Retired Reserve with an effective date of 24 August 2021. t. An NGB Form 22A (National Guard Bureau Correction to NGB Form 22) was issued on 28 January 2022 and outlined the following corrections in the below listed item numbers: * 8B – delete 2020/01/26; add 2021/08/23 * 10D – delete 19 years, 0 months, and 0 days; add 20 years, 6 months, and 27 days * 10A – delete 19 years, 0 months, and 0 days; add 20 years, 6 months, and 27 days * 13 – delete 11B30 Infantryman - 3 years 10 months//12B30 Combat Engineer - 15 years 8 months; add 11B30 Infantryman - 5 years 4 months//12B30 Combat Engineer - 16 years 2 months * 18 – add member completed IET/ADT/ADR/MOB from (20020722-20020913, 20030125-20040607, 20050818-20070212, 20070306-20080519, 20080818- 20091022) * 23 – delete 6-35A ETS; add 6-35L(8) “Medically Unfit for Retention per AR 40- 501” 4. By regulation (AR 600-8-4), a formal LOD investigation is a detailed investigation that normally begins with DA Form 2173 (Statement of Medical Examination and Duty Status) completed by the medical treatment facility and annotated by the unit commander as requiring a formal LOD investigation. Commanders must initiate and complete LOD investigations, despite a presumption of Not In the Line of Duty, which can only be determined with a formal LOD investigation. 5. By regulation (AR 635-40), the Army disability system sets forth policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his or her office, grade, rank, or rating. a. Armed Conflict. The fact that a Soldier may have incurred a medical impairment during a period of war, in an area of armed conflict, or while participating in combat operations is not sufficient to support a finding that the disability resulted from armed conflict. There must be a definite causal relationship between the armed conflict and the resulting unfitting disability. b. Combat related. Covers those injuries and diseases attributable to the special dangers associated with armed conflict or the preparation or training for armed conflict. A physical disability will be considered combat related if it causes the Soldier to be unfit or contributes to unfitness and was incurred under any of the following circumstances: * As a direct result following armed conflict. * While engaged in hazardous service. * Under conditions simulating war. * Caused by an instrumentality of war 6. By law (Title 26, USC, section 104), authorizes special rules for combat-related injuries for compensation for injuries or sickness. For purposes of this subsection, the term "combat-related injury" means personal injury or sickness (A) which is incurred (i) as a direct result of armed conflict, (ii) while engaged in extra-hazardous service, or (iii) under conditions simulating war; or (B) which is caused by an instrumentality of war. 7. The law (Title 10, USC, section 1413a) defines the term "combat-related disability" means a disability that is compensable under the laws administered by the Secretary of Veterans Affairs and that (1) is attributable to an injury for which the member was awarded the Purple Heart; or (2) was incurred (as determined under criteria prescribed by the Secretary of Defense) (A) as a direct result of armed conflict; (B) while engaged in hazardous service; (C) in the performance of duty under conditions simulating war; or (D) through an instrumentality of war. 8. MEDICAL REVIEW: a. The Army Review Boards Agency (ARBA) Medical Advisor reviewed the supporting documents, the Record of Proceedings (ROP), and the applicant's available records in the Interactive Personnel Electronic Records Management System (iPERMS), the Armed Forces Health Longitudinal Technology Application (AHLTA), the Health Artifacts Image Management Solutions (HAIMS) and the VA's Joint Legacy Viewer (JLV). The applicant requests for his Not-In Line of Duty medical discharge to be upgraded to In-Line of Duty discharge. He contends that the VA has service connected his Asthma and PTSD conditions. b. The complete available military record was summarized in the ABCMR ROP. The applicant entered service in the Army National Guard 27Jan2001. He was deployed to Iraq/Kuwait 20030411 to 20040324; 20051128 to 20060510; 20081025 to 20090802. The applicant’s Army National Guard Annual Statement dated 28Jan2022 showed the last period of active duty greater than 30 days ended 22Oct2009. On 25May2021, the applicant received notification that as a result of his Fitness for Duty evaluation, he was no longer medically qualified for retention in service due to his current condition. The permanent profile dated 11Apr2021 reportedly listed the medically disqualifying condition(s); however, this profile was not contained in the available record. A permanent P3 physical profile listing only Persistent Asthma signed by the approving authority on 13Apr2019 was noted in the applicant’s record. He was advised that if he disagreed with the non retention decision, he could undergo further evaluation via a Non-Duty Related PEB. Ultimately, the applicant was discharged from the Washington Army National Guard effective 23Aug2021. It was also noted that the applicant was service connected by the VA for PTSD at 70% effective 16Mar2019, and for Bronchial Asthma at 30% effective 05Aug2021. c. PTSD (1) 03Aug2009 Psychiatry Fort McCoy. The applicant was seen after his 3rd deployment for a post deployment behavioral health screening occupational health/fitness exam. Screenings for alcohol misuse/abuse, PTSD and TBI were all negative. (2) 25Jan2010 Special Psychiatric Exam for PTSD C&P Exam. The applicant had not previously had any BH (behavioral health) treatment. At the time of the exam, he was not employed and was living off savings. He was doing well in his online college-level course study in computer work (GPA 3.8). He endorsed anhedonia, chronic sleep disturbance, a somewhat sad outlook, emotional numbing, heightened arousal, and he was having intrusive recollections of wartime events in both dreams and daytime thoughts. He also endorsed trying to avoid reminders about combat stressors. He attributed the deterioration of his marriage to his symptoms and behavior. He had a history of alcohol excess several years prior but no longer. He completed three separate deployments to the war zone in Iraq. Stressors: Seeing gruesome sights including injuries at close hand; and being in the midst of firefights, and occasional explosions. Diagnoses: Chronic, Mild PTSD (provisional diagnosis); and Adjustment Disorder with Depressive Mood. There was no history of TBI. (3) There were no DoD or VA treatment records from 20Mar2010 until 24Oct2017. (4) 24Oct2017 Deployment & Environmental Health Note. He went to DeVry University and was currently working fulltime in management as a workflow specialist at Honeywell. Screenings for alcohol misuse/abuse, depression, PTSD, and TBI were negative. (5) 21Feb2018 Initial Mental Health Note. He was endorsing numerous PTSD symptoms and appeared to use work/multi-tasking to manage his symptoms. The symptoms contributed to minimal/no functional impairment in workplace. He denied any BH treatment. His PCL-5 score was 41 (scores between 41-60 were consistent with severe self-reported symptoms. (6) 01May2018 Telephone Encounter Note. It appeared his anxiety/PTSD symptoms improved since he started treatment of his dyspnea (difficulty breathing). (7) 28Jan2019 Mental Health Note. He stated that he could not handle stress; but appeared to be doing well in his job and had received a recent promotion. He was working as an ISC Supervisor in the aerospace field (at Honeywell), coordinating repair for aircrafts. His Mental Status Exam was significant for an angry mood and dysthymic and anxious affect, as well as a constricted range of affect. Diagnoses: Adjustment Disorder with Mixed Depressed and Anxious Mood (due to recent relationship break up) and PTSD. He started medication for the first time and agreed to therapy. (8) 29Mar2019 Mental Health Note. In his work role in aerospace maintenance, he provides customer service to high level management for major airlines. Since starting the medication has been much more calm and interpersonally effective to the point that he is now the “go-to-guy” for one of the major airlines. He is also sleeping better. (9) 03May2019 Addendum to 30Apr2019 Primary Care Psychiatric Care Note. He endorsed the full range of DSM criteria for Gender Dysphoria (reportedly first disclosed 29Mar2019). He also disclosed having experimented with hormone replacement therapy (HRT) in the community (estradiol, spironolactone). He had concerns about transitioning in his workplace and also while still in the military. With regard to PTSD and Depression diagnoses, he reported continued great response and tolerability to Zoloft. He was functioning optimally at work such that he had been awarded another promotion. Mental Status Exam was normal. (10) 23Aug2019 Mental Health Note. He has placed as team leader, in charge of moving the aerospace company to Kansas. He was doing well and felt able to manage this role and the associated stress and was very thankful for the positive effect Zoloft had on his mood/anxiety struggles. (11) 19Mar2020 Mental Health Primary Care Note. He had started HRT December 2019 but stopped it after one month due to worsening depression, and sleep issues while on it. He stabilized post cessation of HRT. Mental Status Exam: Mood was generally euthymic with congruent affect. (12) 02Apr2021 Polytrauma Consult. The applicant was formally diagnosed by the VA with two mild TBIs one during Iraq deployment, and a more significant blast exposure during pre-deployment training. The provider opined the applicant’s current clinical symptom presentation was most consistent with “a combination of OEF/OIF deployment related TBI and Behavioral Health condition(s)”. Noted related issues included Sleep Issues (sleep study to rule out obstructive sleep apnea was recommended), Vestibular Dysfunction and Headaches. Related symptoms were not severe—he was maintaining fulltime employment. It was determined there was no need for rehab or case management by polytrauma. (13) 08Jul2021 Psychology Consult. The applicant presented as a transgender woman. She was working as an advanced electrical engineer for Honeywell. She had recently moved from for the new position. She was requesting an evaluation in order to obtain a letter of support for use of hormone therapy. She endorsed initially becoming aware of her gender dysphoria in 2003. She had concerns that the condition was the result of mild TBI in 2003. The BH examiner assessed that that applicant’s condition was NOT a symptom/result of another mental health disorder. In addition, they concluded that the applicant was an acceptable candidate for gender affirming hormone—there were no significant mental health concerns and PTSD symptoms were sufficiently managed by the current treatment. The applicant was recommended to continue BH follow up during HRT to ensure continued stability her PTSD. d. Asthma (1) 27Jan2001 Report of Medical History for enlistment into the Army National Guard, he did NOT endorse a history of Asthma. (2) 22Apr2004 Post-Deployment Health Assessment (PDHA on DD Form 2796). The applicant checked ‘yes’ to difficulty breathing while deployed, but he did not endorse that he was currently experiencing difficulty breathing. (3) 16Nov2006 PDHA 20051128-20060510. He deployed in his MOS 21B Engineer. The applicant reported the following relevant exposures while deployed to Iraq: ‘Smoke from burning trash or feces’, ‘vehicle or truck exhaust fumes’, ‘sand/dust’, and ‘depleted uranium’ from a previous deployment. He did NOT endorse chronic cough, difficulty breathing or chest pain during this deployment. (4) 03Aug2009 Pre-Deployment Assessment. He did not endorse difficulty breathing. (5) 06Dec2009 Post-Deployment Health Re-Assessment (PDHRA). Trouble breathing was NOT endorsed. (6) 03Feb2010 General Medical C&P Exam. Relevant history included exposure to burn pits in 2003 and 2008. He also reported that in 2003, he was exposed to depleted uranium when he was involved in demolition of 200-300 rounds of munitions containing depleted uranium. Since exposure to burn pits, he felt more easily winded while walking and running and occasionally he felt tightness in his chest. Pulmonary function tests (PFTs) were ordered but he reportedly did not respond to messages for him to call and schedule testing. Assessment: Insufficient evidence to support a diagnosis of chronic disease related to burn pit and depleted uranium exposure. (7) 08Dec2012 Functional Capacity Certificate Form. No prescription medications. No profiled condition. No endorsed physical limitations to include ability to run/jog 2 miles. (8) 24Oct2017 Deployment & Environmental Health Note. Discussed his three deployments. He worked construction between deployments. Of note, he reported increasing difficulty passing his 2-mile APFT run. (9) 10Dec2017 PFT Report revealed severe ventilatory impairment due to combined restriction and obstruction. The forced expiratory volume in 1 second (FEVI) per cent change post use of albuterol was 61%. More than 12 percent increase in FEVI following the administration of an inhaled bronchodilator or prolonged corticosteroid therapy meets definition of Asthma per AR 40-501 chapter 3-27. (10) A follow up 14Mar2018 chest CT (for further evaluation for parenchymal lung disease due to finding the restrictive defect) revealed a normal exam: There was no cardiopulmonary disease process. (11) 15Feb2018 Primary Care Initial Evaluation Note. He reported wheezing usually upon awakening and with running. He stated that he was not able to keep up with his national guard team. An inhaler was prescribed during this visit. This note did NOT affirm any previous use of inhaler for Asthma. This is important because any previous APFT was completed WITHOUT use of albuterol inhaler. (12) 14Mar2018 chest CT no cardiopulmonary disease process found. (13) 24Apr2018 Pulmonary Consult. The applicant reported onset of dyspnea in 2013: He had intermittent chest tightness and wheezing of varying severity but the trend was generally progressive. Triggers included exertion and cold temperatures. Symptoms were helped by use of albuterol inhaler. The Pulmonary and Critical Care Fellow reviewed the applicant’s exposure history and appeared to implicate burn pit exposure as the probable etiology. (14) 13Jun2018 PFTs results were normal—no evidence of restrictive disease. (15) 13Jun2018 Addendum. The Pulmonary and Critical Care Fellow annotated that the cardiopulmonary exercise testing on that date was normal. They also affirmed the applicant’s Asthma diagnosis. They noted that the applicant’s condition had normalized with treatment (Symbicort). He was clinically stable and needed no further pulmonary follow up. (16) 08Nov2018 Pulmonary Consult Request. The requesting physician stated the reason for the request was that the applicant was still requiring frequent inhaler use for annual training in National Guard. He had also been excused from any forest fire related duty. The pulmonary specialist responded that we were only 10-15 years out from OEF/OIF, and as such, the long-term effects of burn pit exposure were unknown. They opined that given the Asthma diagnosis, the condition was likely to be chronic with possible intermittent exacerbations. (17) 23Jan2019 VA C&P Medical Opinion concerning respiratory condition due to burn pit exposure: The applicant's current Intermittent Asthma was less likely than not (less than 50% probability) incurred or caused by or related to his Gulf War Environmental Exposure because there was no current peer review medical literature directly showing a causative nexus for being exposed to Gulf War Environment, specifically burning pits, and asthma. (18) 11Apr2019 Standard Form 600. The applicant reportedly used albuterol inhaler prior to taking his APFT; however, he failed 3 consecutive run events on the following dates: 10Sep2017, 09Feb2018 and 04May2018. “Drill related activities (specifically strenuous) worsen and exacerbate the symptoms”. As previously noted, the medical record revealed that the applicant did not start treatment for his asthma until 15Feb2018. (19) On 13Apr2019, a permanent P3 physical profile for Persistent Asthma was signed by approving authority. All functional activities and all APFT events were prohibited. (20) The 23Apr2019 memorandum indicated that the medical retention determination point (MRDP) for Asthma had been reached, and the condition failed medical retention standards. (21) 13Jul2019 Sworn Statement. The applicant wrote that he began noticing symptoms in 2013 due to a decline in his APFT scores. e. The applicant did report difficulty breathing while he was in theatre during his 2003/2004 Iraq deployment; however, breathing difficulties were not reported at the post deployment reassessment or during subsequent deployments. Despite the VA ultimately service connecting the applicant’s Asthma condition, there were no service treatment visits in AHLTA, or records submitted from outside for ongoing breathing/respiratory complaints while the applicant was on active orders. The applicant’s Army National Guard Annual Statement dated 28Jan2022 showed the last period of active duty with duration greater than 30 days ended 22Oct2009. From this date until 24Oct2017, there were no records in JLV or submitted outside records regarding ongoing breathing difficulties. The first objective evidence for the Asthma condition (as well as its impact on performance) was the first failed 2-mile8 run APFT in September 2017. Notwithstanding the pulmonary fellow endorsing that the applicant’s Asthma was due to burn pit exposure; based on available records, there was insufficient objective contemporaneous medical evidence, as well as insufficient objective interval medical evidence to provide a nexus between burn pit exposure in 2003 and/or 2008- 2009 and receipt of the Asthma diagnosis in December 2017. Therefore, In-Line of Duty designation is NOT recommended for the Persistent Asthma condition at this time. f. The Asthma condition was determined to have failed medical retention standards of AR 40-501 chapter 3. Despite treatment, the applicant still had deficiencies in performance. He could not pass the APFT 2-mile run. MRDP was met and he was given a permanent P3 physical profile. g. The applicant’s PTSD condition was determined to be the result of combat deployments. Based on review of available evidence, there was insufficient medical evidence to support that the PTSD condition failed medical retention standards of AR 40-501 chapter 3. The record showed an S1 profile. There was no suicide or homicide ideation. The PTSD condition responded to treatment and did not require duty accommodations or inpatient hospitalization. The Gender Dysphoria diagnosis was disclosed 29Mar2019. The condition was not considered to be the result of PTSD nor was it exacerbated by his PTSD condition. The Gender Dysphoria diagnosis was not considered to be the result of VA diagnosed traumatic brain injury, nor was it exacerbated by this condition. The Gender Dysphoria is a condition not considered to be a disability by the DoD. By regulation, this applicant would not be separated, discharged, or denied reenlistment or continuation of service solely based solely on the Gender Dysphoria diagnosis. DoD Instruction 1300.28 Military Service by Transgender Persons and Persons with Gender Dysphoria effective 04Sep2020 was reviewed among other relevant references. BOARD DISCUSSION: 1. After reviewing the application, all supporting documents, and the evidence found within the military record, the Board found relief is not warranted. 2. The Board concurred with the conclusion of the ARBA Medical Advisor that the applicant did not have any conditions incurred in the line of duty that rendered him unable to perform his duties. He did, however, have non-duty-related conditions that were a basis for his separation. Based on a preponderance of the evidence, the Board determined the non-duty-related designation in this case is not in error or unjust. BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 : : : GRANT FULL RELIEF : : : GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING :X :X :X DENY APPLICATION BOARD DETERMINATION/RECOMMENDATION: The evidence presented does not demonstrate the existence of a probable error or injustice. Therefore, the Board determined the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned. I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case. REFERENCES: 1. Army Regulation 600-8-4 (Line of Duty Policy, Procedures, and Investigations) prescribes policies and procedures for investigating the circumstances of disease, injury, or death of a Soldier providing standards and considerations used in determining LOD status. a. A formal LOD investigation is a detailed investigation that normally begins with DA Form 2173 (Statement of Medical Examination and Duty Status) completed by the medical treatment facility and annotated by the unit commander as requiring a formal LOD investigation. The appointing authority, on receipt of the DA Form 2173, appoints an investigating officer who completes the DD Form 261 (Report of Investigation Line of Duty and Misconduct Status) appends appropriate statements and other documentation to support the determination, which is submitted to the General Court Martial Convening Authority for approval. b. The worsening of a pre-existing medical condition over and above the natural progression of the condition as a direct result of military duty is considered an aggravated condition. Commanders must initiate and complete LOD investigations, despite a presumption of Not In the Line of Duty, which can only be determined with a formal LOD investigation. c. An injury, disease, or death is presumed to be in LOD unless refuted by substantial evidence contained in the investigation. LOD determinations must be supported by substantial evidence and by a greater weight of evidence than supports any different conclusion. The evidence contained in the investigation must establish a degree of certainty so that a reasonable person is convinced of the truth or falseness of a fact. 2. Army Regulation 635-40 (Disability Evaluation for Retention, Retirement, or Separation) establishes the Army Disability Evaluation System and sets forth policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his office, grade, rank, or rating. a. Armed Conflict. The fact that a Soldier may have incurred a medical impairment during a period of war, in an area of armed conflict, or while participating in combat operations is not sufficient to support a finding that the disability resulted from armed conflict. There must be a definite causal relationship between the armed conflict and the resulting unfitting disability. b. Combat related. Covers those injuries and diseases attributable to the special dangers associated with armed conflict or the preparation or training for armed conflict. A physical disability will be considered combat related if it causes the Soldier to be unfit or contributes to unfitness and was incurred under any of the following circumstances: * As a direct result following armed conflict. * While engaged in hazardous service. * Under conditions simulating war. * Caused by an instrumentality of war 3. Army Regulation 40-501 (Standards of Medical Fitness) governs medical fitness standards for enlistment, induction, appointment, retention, and separation (including retirement). Once a determination of physical unfitness is made, disabilities are rated using the VA schedule of disability rating. 4. Title 38, United States Code, Section 1110 (General - Basic Entitlement) sates for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during a period of war, the United States will pay to any Veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation as provided in this subchapter, but no compensation shall be paid if the disability is a result of the Veteran's own willful misconduct or abuse of alcohol or drugs. 5. Title 38, United States Code, Section 1131 (Peacetime Disability Compensation - Basic Entitlement) states for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during other than a period of war, the United States will pay to any Veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation as provided in this subchapter, but no compensation shall be paid if the disability is a result of the Veteran's own willful misconduct or abuse of alcohol or drugs. 6. Title 10, U.S. Code, section 1413a, as amended, established CRSC. CRSC provides for the payment of the amount of money a military retiree would receive from the VA for combat-related disabilities if it were not for the statutory prohibition for a military retiree to receive a VA disability pension. Payment is made by the Military Department, not the VA, and is tax free. Eligible members are those retirees who have 20 years of service for retired pay computation (or 20 years of service creditable for Reserve retirement at age 60) and who have disabilities that are the direct result of armed conflict, especially hazardous military duty, training exercises that simulate war, or caused by an instrumentality of war. CRSC eligibility includes disabilities incurred as a direct result of: * armed conflict (gunshot wounds, Purple Heart, etc.) * training that simulates war (exercises, field training, etc.) * hazardous duty (flight, diving, parachute duty) * an instrumentality of war (combat vehicles, weapons, Agent Orange, etc.) //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20220006071 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1